Eliminating desflurane use: A clinician-led pathway to low-carbon anaesthesia

In 2022, FSFB’s director established an institutional policy to advance sustainable, resilient, and low-carbon healthcare. As part of this policy, the hospital created a Sustainability Committee, which engaged anaesthesiologists through presentations and discussions on desflurane’s contribution to climate change.

In this context, a group of anaesthesiologists at FSFB began critically examining their use of anaesthetic gases, particularly desflurane. After learning about desflurane’s significant impact on global warming, they took action to reduce its use.

Solution proposed

Awareness-raising efforts led by the Sustainability Committee empowered a group of anaesthesiologists at FSFB to question existing anaesthetic practices and develop a strategy to reduce desflurane use and, therefore, lowering the hospital’s emissions. Recognizing the technical complexity of measuring the carbon emissions of the anaesthetic gases, the team decided to start by a costs analysis. This assessment revealed that desflurane was substantially more expensive than alternatives such as sevoflurane, reinforcing the need for change by aligning environmental sustainability with financial savings.

With the support and approval of the head of the anaesthesiology department, the group of anaesthesiologists implemented a phased strategy to remove desflurane vaporizers from ORs. In the first phase, the anaesthesiologists removed most desflurane vaporizers. Out of 12 ORs, only three retained desflurane vaporizers.

Because some anaesthesiologists initially resisted the change, part of the strategy was to keep a limited number of vaporizers available to ease the transition and avoid the perception that clinicians were being told how to practice. Vaporizers were then removed progressively, year by year. In line with this approach, when FSFB built a new facility in 2023, the ORs in the new building did not incorporate desflurane vaporizers. Throughout the transition period, the Sustainability Committee continued to engage anaesthesiologists, understand the reasons behind continued desflurane use, and highlight the environmental benefits and financial savings of reducing it.

These discussions also revealed that some clinicians used desflurane almost automatically, despite having alternatives available, such as sevoflurane and isoflurane, and despite the fact that patient outcomes are not significantly better with desflurane than with sevoflurane.

If you want to learn more about the challenges they faced and the impact of their work, you can check the full case study here!